目的:尽管全膝关节置换术(TKA)是治疗终末期关节炎最成功的方法之一,接受此手术的患者中仍有近20%不满意.已经引入了各种设计选项来减少该患者队列。一种这样的选择是引入中间叠合(MC)聚乙烯设计。进行这项研究是为了评估接受双侧单阶段TKA的患者的结果测量和步态分析,其中对侧膝盖保留或切除了后交叉韧带(PCL)。
方法:2021年7月至9月,由一名外科医生使用MC设计选项进行60例双侧TKA。研究对象包括年龄在55至70岁之间的退行性病因固定的内翻畸形患者,以及KellgrenLawrence3级和4级放射学变化.排除标准是以前的下肢手术,血清阳性关节病,创伤后关节炎,外翻畸形,屈曲挛缩>20°,和任何预先存在的病理影响步态,例如,脊髓灰质炎,或者神经肌肉疾病。为了本研究的目的,在对侧保留或处死PCL。功能分数,在18个月的随访中评估了水平行走和梯度行走的结果和步态分析.
结果:在18个月时,PCL保留侧(MC-PCL)的运动范围(ROM)从术前的值97.3±11.5提高到110.3±6.1,在PCL切除侧(MC-PCLX)从96.5±10.8提高到113±5.8。膝关节社会评分(KSS-2011)在术后18个月时在MC-PCL侧从21.2±4.5提高到89.8±3.4,在MC-PCLX侧从21.5±4提高到88.2±3.7。术后18个月,MC-PCL侧的遗忘关节评分(FJS-12)为8.8±0.7,MC-PCLX侧的遗忘关节评分为8.1±0.9。我们的步态分析评估表明,当受试者向上倾斜30°时,与MC-PCLX组相比,MC-PCL组的前足压力较低。发现这种差异具有统计学意义。
结论:在这项研究中,虽然在MC-PCLX研究批次中ROM更大,MC-PCL研究批次患者满意度较高.步态评估表明,与MC-PCLX研究批次相比,MC-PCL研究批次的前足压力较低,同时倾斜30°,接近正常步态模式。
方法:II.
OBJECTIVE: Despite Total Knee Arthroplasty (TKA) being one of the most successful procedures for end stage arthritis, nearly 20% of patients undergoing this procedure remain dissatisfied. Various design options have been introduced to reduce this cohort of patients. One such option has been the introduction of the medial congruent (MC) polyethylene design. This study was undertaken to evaluate outcome measures and gait analysis in patients undergoing bilateral single stage TKA where the posterior cruciate ligament (PCL) was retained or excised in contralateral knees.
METHODS: 60 bilateral TKA\'s were performed by a single surgeon using a MC design option from July to Sep 2021. The study lots included patients between the ages of 55 and 70 years with fixed varus deformity of degenerative aetiology, and Kellgren Lawrence Grade 3 and 4 radiological changes. Exclusion criteria were previous surgery to the lower extremities, sero positive arthropathies, post traumatic arthritis, valgus deformity, flexion contractures > 20°, and any pre-existing pathology impacting gait, e.g., poliomyelitis, or neuromuscular disorders. The PCL was retained or sacrificed on contralateral sides for the purpose of this study. Functional scores, outcomes and gait analysis on level and gradient walking were evaluated at a follow-up of 18 months.
RESULTS: At 18, months the Range of Motion (ROM) improved from a preoperative value of 97.3 ± 11.5 to 110.3 ± 6.1 on the PCL retained side (MC-PCL) and from 96.5 ± 10.8 to 113 ± 5.8 on the PCL excised side (MC-PCLX). Knee Society Score (KSS-2011) improved from a preoperative value of 21.2 ± 4.5 to 89.8 ± 3.4 at 18 months postoperatively on the MC-PCL side and from 21.5 ± 4 to 88.2 ± 3.7 on the MC-PCLX side. Forgotten Joint Score (FJS-12) was 8.8 ± 0.7 on the MC-PCL side and 8.1 ± 0.9 on the MC-PCLX side 18 months after surgery. Our gait analysis evaluation demonstrated a lower forefoot pressure in the MC-PCL group in comparison to the MC-PCLX group when subjects were made to walk on a 30° upward incline. This difference was found to be statistically significant.
CONCLUSIONS: In this study, while ROM was greater in the MC-PCLX study lot, patient satisfaction was higher in the MC-PCL study lot. Gait assessment demonstrated lower forefoot pressure while ascending an incline of 30° in the MC-PCL study lot as compared to the MC-PCLX study lot approximating normal gait patterns.
METHODS: II.